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Friday, January 14, 2011

Zema, the Warrior Princess

Voov has reached a new stage. Like HAL in Stanley Kubrick's 2001, she has become self-aware. Hidden B informs me that earlier today, Voov raised her arm, pointed at her wrist (which is always red and inflamed, because we can't put steroids anywhere near her hands) with the forefinger of the other hand, and, for the first time, spoke the word "Zema."

Zema, the Warrior Princess.

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Yesterday, Caroline at Fighting Eczema posted about her son's recent scratching attack and how she has begun to suspect that dust mites might be partly responsible for his eczema. (Specifically, it's the dust mite droppings that are the allergen.) I have always been aware of the dust mite issue, but because eczema is maddeningly inconsistent and hard to connect to any causes, even though at times it seems certain that some foods or allergens trigger flares--and because it would take a lot of time, effort, and money to attempt to control dust mites in our house, I have never done anything about them.

Vacuum? Sure, we do that once in a while. But vacuuming probably stirs up dust mite droppings and blows them into the air. Read Caroline's blog for details on what you'd have to do to begin to control dust mites.

And so it occurred to me that dust mites--and grass pollen, another thing it's virtually impossible to control exposure to--are the two most important targets for immunotherapy for eczema patients.

Three papers (here, here, and here) from the current issue of JACI show that we could expect these therapies to make it to the clinic. The grass pollen treatments are tablets, taken for about 6 months, and improved symptoms in both kids and adults by about 20% on some qualitative scale of hay fever misery. The dust mite treatments may have been injections (I don't have access to the full paper right now) and were taken over 3 years (hoo boy) but the researchers found improvements of about 45% in hay fever and 80% in asthma, so they were definitely more effective.

I'd say that the NEA should consider funding some of this research (they may already be doing so) to translate these findings into FDA-approved therapies, at least in the case of dust mites. Are the scientists considering founding a company, or patenting and licensing their discovery?

* * *

It's taken a while, but I have made an appointment to speak to Martin Steinhoff, a visiting professor of dermatology at UCSF, about the German itch center model. I'll be talking to him on January 25th. (He's visiting from the University of Muenster.) In advance of our meeting, he's given me a couple references to his papers, and I'm reading one at the moment: a review of how the skin, nervous system, and brain work together to create the sensation of itch. It's eye-opening stuff and I'll share some key points with you when I understand them! Let me give you just one quote:

"...the impression that one's skin itches is nothing but a sensory illusion created by the brain."

So, you'd think, you don't necessarily have to treat itchy skin to control itch. You could take something that acts directly on the brain. Pop a tablet, instead of smearing yourself with steroids.

"Zema" is kind of bittersweet--cute spoken words coming from a child, but unpleasant that she has to know what it even is. Have you tried Protopic? It's worked wonders for my kid on tough to heal areas like fingers and eyelids. Usually one dose does it, which I apply at night after he's sleeping so I don't have to worry about him ingesting it or getting in his eyes.

I should add that I learned to pronounce "eczema" as "ecZEEma" rather than "EKsema" because I grew up in Canada. Now I pronounce it both ways. Voov has obviously copied the first.

Haven't tried Protopic yet-- we are trying to stay as drug-free as possible. I tried it once myself and it didn't work, unfortunately. (Well, it did burn and gave me a terrible headache, but did nothing for the itch.) We'll probably give it a shot at some point.

SSS--according to the first paper I've read by Steinhoff, it's well known that psychology (through effects at the molecular level) makes the connection between stress and itch more intense, in the same way as happens with chronic pain. For chronic pain, training techniques exist to reduce the connection. There's nothing officially developed for itch yet, though.